Trends in admissions, morbidity and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, 2004 - 2013

Isaacs-Long, Y; Myer, Landon; Zar, Heather J.

doi:10.7196/samj.2017.v107i3.11364

Cited by 12 publications

(10 citation statements)

References 20 publications

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“…An age range of 4 months to 13 years was specified for this guideline, because children in this range have relatively homogenous sleeping patterns (Claustrat, Brun & Chazot 2005 ). This age range also matches the age ranges treated at the target facility (Isaacs-Long, Myer & Zar 2017 ).…”

Section: Research Methods and Designsupporting

confidence: 74%

Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses

Crous

North

2021

Curationis

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Background: Adequate sleep in hospitalised children is important for a variety of physiological and psychological processes associated with growth, development, and recovery from illness and injury. Hospitalisation often prioritises clinical care activities at the expense of age-appropriate sleep. Nurses and the wider healthcare team contribute to this paradox. However, through conscious practice and partnering with mothers, nurses are able to enact change and promote sleep.Objectives: To adopt, adapt or contextualise existing guidelines to develop an evidence-based practice guideline to promote sleep-friendly ward environments and routines facilitated by nurses, and in partnership with mothers.Method: A six-step methodology for guideline adaptation was followed, as recommended by the South African Guidelines Excellence project: (1) existing guidelines and protocols were identified and (2) appraised using the AGREE II instrument; (3) an evidence base was developed; (4) recommendations were modified, (5) assigned levels of evidence and grades of recommendation; and (6) end user guidance was developed. Expert consultation was sought throughout.Results: Existing relevant guidance comprised 61 adult-centric recommendations. Modification of the evidence base led to six composited recommendations that facilitate sleep in hospitalised children: (1) prioritising patient safety; (2) collaborating with the mother or caregiver to promote sleep; (3) coordinating ward routine and (4) environment to improve sleep; (5) work with clinical and non-clinical staff; and (6) performing basic sleep assessments. Practice recommendations were aligned to the South African regulatory framework for nursing.Conclusion: Hospitalisation is a time of physiological and psychological dysregulation for children, which is amplified by poor sleep in a hospital. Nurses have the opportunity to promote sleep during hospitalisation by implementing this African-centric guideline in partnership with mothers.

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Section: Research Methods and Designsupporting

confidence: 74%

Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses

Crous

North

2021

Curationis

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“…Despite choosing sites with large paediatric ART clinics, where we expected to find admissions of HIVinfected children to be concentrated, our survey included a relatively low number of HIV-infected children among those admitted. We interpret this as evidence of the efficacy of PMTCT, which has resulted in decreasing paediatric HIV incidence and prevalence [2], and of the generally high efficacy and low toxicity associated with current paediatric antiretroviral regimens in use. Nevertheless, among the small number of HIV-infected children admitted during our survey, a high proportion (9/ 29, 31%) had ADRs, which is comparable to another South African survey in which 9/21 (43%) HIV-infected children admitted to hospital had ADRs [19].…”

Section: Discussionmentioning

confidence: 94%

“…South Africa was home to an estimated 280,000 children living with HIV in 2017, of which an estimated 58% were on antiretroviral treatment (ART) [2]. Despite this high prevalence of HIV, and despite ART's notorious potential to cause adverse drug reactions (ADRs) and drug-drug interactions, drug safety is a relatively understudied field in South Africa.…”

Section: Introductionmentioning

confidence: 99%

Serious adverse drug reactions at two children’s hospitals in South Africa

et al. 2020

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Background: The high HIV prevalence in South Africa may potentially be shaping the local adverse drug reaction (ADR) burden. We aimed to describe the prevalence and characteristics of serious ADRs at admission, and during admission, to two South African children's hospitals. Methods: We reviewed the folders of children admitted over sequential 30-day periods in 2015 to the medical wards and intensive care units of each hospital. We identified potential ADRs using a trigger tool developed for this study. A multidisciplinary team assessed ADR causality, type, seriousness, and preventability through consensus discussion. We used multivariate logistic regression to explore associations with serious ADRs. Results: Among 1050 patients (median age 11 months, 56% male, 2.8% HIV-infected) with 1106 admissions we found 40 serious ADRs (3.8 per 100 drug-exposed admissions), including 9/40 (23%) preventable serious ADRs, and 8/40 (20%) fatal or near-fatal serious ADRs. Antibacterials, corticosteroids, psycholeptics, immunosuppressants, and antivirals were the most commonly implicated drug classes. Preterm neonates and children in middle childhood (6 to 11 years) were at increased risk of serious ADRs compared to infants (under 1 year) and term neonates: adjusted odds ratio (aOR) 5.97 (95% confidence interval 1.30 to 27.3) and aOR 3.63 (1.24 to 10.6) respectively. Other risk factors for serious ADRs were HIV infection (aOR 3.87 (1.14 to 13.2) versus HIV-negative) and increasing drug count (aOR 1.08 (1.04 to 1.12) per additional drug). Conclusions: Serious ADR prevalence in our survey was similar to the prevalence found elsewhere. In our setting, serious ADRs were associated with HIV-infection and the antiviral drug class was one of the most commonly implicated. Similar to other sub-Saharan African studies, a large proportion of serious ADRs were fatal or near-fatal. Many serious ADRs were preventable.

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“…The preponderance for males to preferentially access health care is a well-known phenomenon and applies to various levels of care in developed and developing countries. 16 More than two thirds of patients experienced a significant delay to presentation. Age, race, main source of monthly income and history of diabetes were significant variables contributing to delay in presentation in the study sample.…”

Section: Discussionmentioning

confidence: 99%

Surgical infections at a regional hospital in Gauteng: reasons for delay to care and profile of pathology

et al. 2019

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Background: Present on arrival infection is a common indication for admission of surgical patients initially managed at primary care level. We aimed to describe the demographic and disease profile of patients presenting with infection requiring surgical management, describe determinants of patients' health-seeking behaviour, and identify barriers to care. Methods: A prospective descriptive questionnaire-based study was conducted at Edenvale General Hospital between February 2014 and October 2016. Minors were excluded. Results: Eighty-nine patients participated. Abscesses (26%), diabetic foot (22%), and cellulitis (16%) were the commonest categories of infection necessitating admission. The majority of patients were South African (88%), Black African (82%), males (58%), without medical aid (99%), who were not formally employed (58%), were from poor households (74%), inhabited some form of formal housing (90%), were in charge of decisions regarding personal health (80%), and first sought help at the primary care level (71%). Delay to presentation was noted in 69% of patients, and delay to referral in 46%. Age, race, history of diabetes, and main source of monthly income were significant variables in delayed presentation (p<0.05), and age and level of care on first contact in delayed referral (p<0.05) in the study sample. The most common reason for delay to presentation (84%) and referral (61%) was patients' belief that their problem would resolve spontaneously. Conclusions: Patients' socio-economic status, past medical history, demographics, level of first contact with the health care system, and perceptions of their own health contributed to delays in seeking and receiving care in the study sample. These delays may be addressed by interventions that target the availability, accessibility, acceptability and affordability of health care services.

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Trends in admissions, morbidity and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, 2004 - 2013

Cited by 12 publications

References 20 publications

Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses

Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses

Serious adverse drug reactions at two children’s hospitals in South Africa

Surgical infections at a regional hospital in Gauteng: reasons for delay to care and profile of pathology

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